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Full text of "A short practical narrative of the diseases which prevailed among the American seamen, at Wampoa in China : in the year 1805 : with some account of diseases which appeared among the crew of the ship New-Jersey, on the passage from thence, to Philadelphia : submitted as an inaugural dissertation, to the examination of the Rev. J. Andrews ..., the Trustees and medical professors of the University of Pennsylvania, on the tenth day of April, 1807 : for the degree of Doctor of Medicine"

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UNITED STATES OF AMERICA 




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FOUNDED 1836 



WASHINGTON, D. C. 



OPO 16—67244-1 



A SHORT 

PRACTICAL NARRATIVE 

OF THE 

DISEASES WHICH PREVAILED AMONG 

THE 

AMERICAN SEAMEN, AT WAMPOA IN CHINA, 

IN THE YEAB^1805 ; 

WITH SOME ACCOUNT OF DISEASES WHICH APPEARED 

AMONG THE CREW OF THE SHIP NEW-JERSEY, 

ON THE PASSAGE FROM THENCE, 

TO PHILADELPHIA. 

SUBMITTED 
As an Inagural Dissertation, 

TO THE EXAMINATION OF THE 

REV. J. ANDREWS, D. D. PROVOST, 

(PRO TEMPORE.) 
THE 

TRUSTEES AND MEDICAL PROFESSORS* 

OF THE 

UNIVERSITY OF PENNSYLVANIA, 

ON THE TENTH DAY OF APRIL, 1807. 
FOR 

THE DEGREE OF DOCTOR OF MEDICINE. 



BY WILLIAM BALDWIN, 

OF PENNSYLVANIA, 

MEMBER OF THE PHILADELPHIA MEDICAL AND 

LINNEAN SOCIETIES. 



" Think, read, and observe. Observe, read, and think for 
yourselves." Rush. 



PHILADELPHIA : 

PRINTED BY THOMAS T. STILES, S. W. CORNER OF 
FRONT AND WALNUT-STREETS. 



1807. 



9 /fy.C L » & 



t/c. 



/Lcj -& C<0~c-< A^ j£^^ 




TO 

DOCTOR WILLIAM A. TODD, 

OF DO WJWJSTGTO WJY, 

IN THE COUNTY OF CHESTER, 

<€&# <©t$frrtation, 

IS GRATEFULLY DEDICATED, AS A SMALL, BUT GENUINE 
TRIBUTE OF RESPECT, NOT ONLY FOR HIS TALENTS 
AS AN ENLIGHTENED AND SUCCESSFUL 

PRACTITIONER OF MEDICINE, 

BUT FOR THE 

AMIABLE} QUALITIES 

WHICH HE POSSESSES AS A MAN, AND FOR THE MANY 
PRIVATE MARKS OF DISINTERESTED FRIEND- 
SHIP, AND ESTEEM, WHICH HE HAS 
SO OFTEN CONFESSED UPON HIS SINCERE FRIEND, 
AND LATE PUPIL, 

THE AUTHOR 



f ntrotmctorp iftemar&& 



IN this short narrative of the diseases, which prevailed a- 
mong the American Seamen at Wampoa, in China, I do not ex- 
pect to add to the list of diseases, nor to bring forward new reme- 
dies in the treatment of them. I believe with Dr. Clark, « that dis- 
eases in every climate are respectively the same," or differ only 
in degree, from the difference in force of the remote cause, or the 
susceptibility of the system to be acted upon by it, and are to be 
subdued by the same remedies, accommodated to circumstances. 

In the mode of treatment, however, which I shall recommend, 
I am obliged to differ from Lind, Clark, and other respectable 
European physicians who have treated of the diseases of warm cli- 
mates, and who have condemned the use of bloodletting, and the 
antiphlogistic mode of treatment altogether. Clark informs us, 
that in both the remitting and intermitting forms of disease, the 
early and liberal exhibition of the bark was most to be depended 
upon, that blood letting was unsafe and often injurious, and even 
prepared the way for visceral obstructions. As I found blood-let- 
ting to be useful, and the early exhibition of the bark to be almost 
uniformly imprpper, and as the work of this respectable physician, 
whose opportunity of acquiring a knowledge of the diseases of In- 
dia and China was very extensive, is, I believe, more generally 
consulted than any other by the medical gentlemen, who enter as 
physicians on board of our merchants ships trading to these ports, 
I was induced to believe that a brief statement of the practice, I 
pursued, and which was found to be the most successful, by all 
the medical gentlemen on board of the different Ships at that time, 
might be of some advantage, in preventing the young practition- 
er from being misled by authorities so respectable. 



I would not however, venture to affirm that the practice 
which I pursued, would always be found the most successful. Dis- 
eases, and particularly Bilious Epidemics, appear to vary in their 
force, not only in different climates, but in the same climate and 
situation, in different seasons, so as to require some variation in 
the treatment. The best way then to avoid being misled, is to at- 
tend to the state of the system, and prescribe accordingly. 



SITUATION OF WAMPOA, 

WITH SOME OBSERVATIONS ON THE STATE OF THE WEA- 
THER, AND PREVAILING FORMS OF DISEASE. 

Wampoa is a large village, situated near the borders of 
the river Tigris, about fifteen miles below the city of Canton*, 
and sixty above Macoa. The ships of all nations trading to the 
port of Canton are stationed here, and the river at this place is 
about half a mile wide, meandering in a westerly direction. — 
Wampoa stands upon the south side of the river, on an extended 
plain, on which rice alone is cultivated, so low that the greatest 
part of it is overflowed by the tide. On the North side of the 
river, French and Danes Islands are situated, which are formed 
by intersections of the river, and are remarkable for the moun- 
tains in them surrounded by morass. 

I arrived here from Europe in the ship New-Jersey of Phila- 
delphia, after a voyage of 125 days, on the 29th of July, at which 
time there were only eight American ships in the harbour. We 
had experienced but little sickness on the voyage, and our crew 
were all now in a state of health. The weather was very sultry, 
with frequent showers of rain, often attended with thunder and 
lightning, and variable winds. There was at this time more or 
less sickness on board of all, or most of the ships, and my friend 
Dr. John Martin, of the Ganges informed me, that it was then 
becoming more sickly, and that several deaths had already occur- 
red. 

The weather continued sultry during the month of August, and 
until the 1 3th there had not been more than two days in succes- 
sion, without frequent heavy showers of rain, alternating with 
hot and oppressive sun-shine, often attended with thunder and 
lightning, but rarely heavy thunder-storms. From this time till the 
I 8th, much rain fell, and the sky was almost constantly obscured. 
We had now one week of fair weather. On the 25th we had a 
tremendous storm of wind and rain from the Southward and VVest- 



• Canton is placed in lat 23. 20. N. and long. ll?. 07" East of London 



8 

ward, which sent many of the ships adrift from their moorings, 
and considerable numbers of the Chinese, residing in their flat- 
bottomed junks, on the water, were upset and drowned. The 
remainder of the month was mostly fair, and the heat rather less 
oppressive. The mercury in Farenheit's Thermometer rang- 
ed from 87 to 90, and never I believe n^» higher than 92. I** 
Fevers, principally of the remitting form, continued to increase 
till about the middle of the month, from which time they began 
to diminish, and on the first of September, there ^vere but few 
cases of sickness in the fleet. Two deaths only occurred. 

The weather in the month of September varied but little upon 
the whole from the preceding : frequent showers of rain, varia- 
ble winds, with alternate hot sunshine, characterized the fore part. 
On the 14th, there was a storm of heavy rain, and the mercury fell 
suddenly from 90 to 83, which proved a change so sensible, that 
cloth clothing was rendered comfortable. Toward the latter end of 
the month, the mornings and evenings were sometimes cool and 
damp, while it was excessively sultry in the middle of the day. 
A foul stench was emitted from the marshes, and the musquitoes 
were very troublesome. At this time there was the greatest num- 
ber of sick, and the remittents had assumed a more malignant as- 
pect. There were upwards of 20 ships now in the harbour, and we 
anticipated an alarming epidemic. But one death, however, oc- 
curred during this month. The month of October was much 
more pleasant than the preceding months. Much less rain fell, 
and the heat was seldom so oppressive. The prevailing winds 
were from the northward, influenced by the monsoons. The sky 
was serene, and contrary to our expectations, we had much less 
sickness. The diseases now appeared principally in the form of 
intermitting fevers. The fore part of November was also plea- 
sant, but the mornings and evenings were cool. About the mid- 
dle of the month a great quantity of vain fell, and during this 
time the weather was unusually sultry. On the 17th we had ano- 
ther severe gale of wind, accompanied with heavy rain, called in 
this country a typhoon, which committed ravages similar to the 
former. We had now several days of cloudy cool weather, with 
easterly winds. On the 21st, a fire in the factories at Canton, 
was rendered indispensible to our comfort. The prevailing dis- 
eases were intermittents, principally of the tertian type. 



Causes which predispose to Disease am o fig Sea- 
men in warm climates. 

Before I proceed to treat of the phenomena and symp- 
toms, I shall enumerate some of the causes which tend eminent- 
ly to predispose to disease and death among seamen in warm cli- 
mates, on first coming into port, and these are, 

First, A change of aliment. The sudden transition from a diet 
of salted animal to both fresh animal and vegetable looa. 1 con- 
sider this a fruitful source of diseases, and one which has been too 
little attended to. Fresh animal food, from the greater nourish- 
ment it contains, produces general as well as local debility., and 
thereby predisposes to general disease with a local determination 
to the bowels. 

2d. Change of drink — and frst of water. This may be in- 
jurious from its quality or quantity : but secondly, a much iiiore 
destructive source of disease and mortality arises from the perni- 
cious practice of drinking spirituous liquors, which is unfortunate- 
ly too universal among sailors, and added to the heat 01 the cli- 
mate, produces a debility, which predisposes to the most malig- 
nant and dangerous forms of disease. 

3d. Exposure to the rays of the sun. Seamen often expose 
themselves with their heads bare, and the consequence is fre- 
quently an attack of fever, or it is sometimes immediately fatal, 
producing a species of apoplexy, or what is termed by the .trench 
" Coup de Soleil." 

4th. Lying upon deck at night, exposed to the damp air, and 
morbid exhalations, without any covering. This is often the effect 
of intoxication, and is generally followed by an attack of fever. 
To these causes might be added, violent exercise, and the prac- 
tice of continuing long in the water. Frequent and moderate 
bathing I believe to be salutary, but it is generally carried to a 
dangerous excess. 

B 



10 
Phenomena and Symptoms. 

A chill, more or less nausea, vomiting, or purging of 
bile, pain, or oppression about tbe praecordia, pain in the head, 
small of the back, or bones in general, are, I believe, symptoms 
that more or less universally characterize the ushering in of bili- 
ous remittents, wherever they prevail. But these symptoms are 
often varied, and in cases of great violence no chill occurs. Many 
cases in the present instance were marked by an early and peculiar 
determination to the brain, attended with giddiness, stupor, or de- 
lirium ; eyes red and inflamed, with flushing of the face. These 
latter symptoms were more particularly evident in those who had 
been using violent exercise, or had been much exposed to the 
influence of the sun's intense rays, and where the bowels were 
constipated. In some cases, and particularly in those who were 
seized immediately after their arrival in port, there was a particu- 
lar determination to the bowels, attended with bilious purging, great 
pain and tenesmus. The premonitory symptoms were generally 
great debility, universal languor and drowsiness ; sometimes an 
uncommon elevation of spirits, preceded an attack of this fever, 
the patients informing me, that they had never felt better than 
they had done the day before. In most of the cases an exciting 
cause could be traced, as violent exercise, exposure to the rays 
of the sun, excess in eating or drinking, lying on deck at night, 
or remaining too long in the water, &c. 

After the formation of the fever, the pulse was generally 
full, but except in a very few cases, rarely imparted a sense of 
tension to the fingers. The skin was parched and hot, thirst ex- 
cessive, and the tongue furred of a yellow colour. 

The remissions were irregular, as influenced by the force 
of the disease, or the remedies applied. If, however, the disease 
was suffered to progress, from entire neglect, or the application of 
feeble remedies, which, fortunately, was the case only in a very 
few instances, the remissions became more indistinct, and the 
continued or typhus form of fever was induced, which was 
extemely difficult to manage, and too frequently terminated soon- 
er or later in death, attended with all the variety of distressing 
symptoms which usually characterize this dangerous form of dis- 
ease. 



11 



General Account of the Treatment. 

When called early, I generally began by opening a vein in 
the arm, from which I drew from 10 to 16 ounces of blood, ac- 
cording to circumstances, which it was seldom necessary to re- 
peat. The blood drawn sometimes exhibited a sizy appearance. 
This evacuation was always attended with the happiest effects, af- 
fording an immediate mitigation of the most alarming and dis- 
tressing symptoms. 

The next remedy that I employed was calomel combined 
with jalap. Ten grains of each was a medium dose. I some- 
times gave 15 of calomel, and 25 of jalap, which in some cases I 
repeated with the happiest effect. These large doses seldom pro- 
cured more than three or four copious stools. In a few cases one 
stool only has been the result, and in one case after repeating it, 
I added half an ounce of sulphate of soda, before an evacuation 
was produced. I afterwards found the calomel in doses of 4 or 
5 grains, combined with a sixth or an eighth of a grain of tartari- 
zed antimony, and given every four, five or six hours, the best febri- 
fuge. These doses I continued in some cases till the fever was 
subdued. The mercury given in this way rarely affected the 
mouth. I sometimes made use of nitre, with or without calomel 
or the emetic tartar. By this mode of treatment the disease was 
often subdued as early as the third day, when I commenced giving 
the peruvian bark, so celebrated in these fevers, and which indeed 
I sometimes found of infinite service, in speedily restoring the pa- 
tient to health, after the sudden removal of the inflammatory dia- 
thesis : but some quickly recovered without taking any, and others 
took so little that no material good effects should be ascribed 
to it. 

Blisters and sinapisms were of service when applied in the 
proper stage of the disease ; the former after the inflammatory 
symptoms were moderated, and the latter accompanied with blis- 
ters, when the disease run on to the typhus stage. In dysenteric 
cases, I began as before, but substituted rhubarb for jalap, and af- 
terwards, if the symptoms continued, gave castor-oil, opium com- 
bined with calomel, or ipecacuanha, with the happiest effect. 



12 

In the month of October, and the remaining part of the sea- 
son, as has been already mentioned, intermittents were the pre- 
vailing forms of disease. These were of a very obstinate inflam- 
matory nature, chiefly of the tertian type. Very few yielded to 
emetics or cathartics, and the use of the peruvian bark alone. — 
Bleeding in every case in which I employed it, evidently accele- 
rated the cure. I then gave strong mercurial cathartics, as I had 
done before in the remitting fever, preferring them to the com- 
mon practice of giving emetics, as they depleted more effectually. 
I then generally succeeded in arresting the disease by the appli- 
cation of blisters, and the exhibition of a large dose of opium 
about half an hour before the expected paroxysm, which had the 
effect of preventing its recurrence, after which the bark perfected 
the cure. 

My friend and fellow graduate, Mr. Thomas Bryant, then 
physician on board the ship Jefferson, informed mc, that he had 
two very obstinate cases at Canton. He bled each of them once, 
and gave strong mercurial cathartics — but was under the necessi- 
ty of inducing a salivation in one of them, before he exhibited 
the bark. 

I intended, in this place to have given a few of the most in- 
teresting cases at full length, but as the time allotted for prepar- 
ing this essay has nearly expired, I hope I shall be excused for o- 
mittin^ it. I have, however, just received an interesting state- 
ment of cases from my obliging friend Mr. Hugh Service, which 
will in a great measure supply the place of them, and tend fur- 
ther to establish the mode of practice which 1 have recommen- 
ded. 

DEAR Sir:, 

Agreeably to your request, I offer you a few obscr-* 
vations on the treatment of the principal diseases which came un- 
der my notice at Wampoa, from the latter end of September to 
the end of December 1805 We remained at Wampoa until the 
23d of March. 1806, but after the month of December 1806, 
there were but few vessels there, and all of them enjoyed good 
health. 

From the conversation that I have had with yGU,the result 
of your experience agrees with that of mine. From reading Clark, 



13 

I had an idea that the hark would he the only vemedy required in 
the fevers of the Eastern tropical climates, and I therefore suppli- 
ed myself with a large quantity of it. But, instead of having oc- 
casion to use it in all cases, without any attention to the exacerba- 
tions or remissions of the fever, as directed by this author, 1 
found it necessary in most cases to abstain from it, until I had pro- 
cured a perfect intermission. 

I am indeed convinced, that if we had pursued Clark's plan, 
we should have had either very few recoveries, or very tedious 
ones : for modes of treatment directly opposite to each other, 
cannot be supposed equally proper in the same forms of disease : 
it is therefore presumable — is it not certain ? thatthe antiphlogis- 
tic treatment was the proper one, as it was attended with suc- 
cess. 

I found bleeding necessary in most of the recent cases oi 
fever arising from marsh miasmata, that came under my notice ; 
and in all which I attended excepting one, which will be mention- 
ed more particularly hereafter. I was careful not to exhibit the 
bark, until I had procured an intermission of the fever. One mo- 
derate bleeding at the commencement, I generally found suffici- 
ent. 

In the first two cases of remittent fever, which came under 
my direction, I gave calomel for the purpose of exciting soreness 
of the mouth, premising bleeding in one of them, and a purgatifl*^ 
in both. On the third day the mouth was affected, and there was 
an intermission of fever, so that I was enabled to begin with the 
bark. They both recovered in a short time. 

I did not think that the treatment with mercury was attend- 
ed with any peculiar advantage in these cases, and therefore did 
not pursue it afterwards. I had only one case in which I thought 
it prudent to exhibit the bark, without having procured a perfect 
intermission of the fever. In this case, (that of a young man on 
board the Active) it was rendered necessary by my having used 
the lancet too freely, and this is the only case where I had reason 
to think that I had used the lancet disadvantageously. I still 
think that bleeding was proper in his case, but it should have been 
limited to a few ounces, or have been drawn more gradually. I 
took twenty-four ounces at two bleedings. — He recovered under 
the use of the bark and wine. 



14 

I saw some cases of intermittents in which the paroxysms 
attacked with so much violence, as to require the lancet repeated- 
ly. In the case of a young man about 20 years old, on board the 
Beaver, the last stage was accompanied with excruciating pain in 
the side and breast, and difficulty of breathing. I saw him in three 
successive paroxysms, and took twelve ounces of blood from him 
each time. The operation always procured immediate relief. 

I was called to see a young man, on board the Pekin, in the 
absence of Dr. Moore, Surgeon of that ship. He complained of a- 
cute pain about the Epigastrium, with an active pulse, and a hot 
but moist skin. I took twelve ounces of blood from him, which re- 
moved the pain, in a short time, but as it returned tho' much less 
violently, I applied a blister and directed 6 grains of Calomel, and 
2 of Opium : By these means he was relieved so much as to ren- 
der it safe to send him to Canton, where he was attended by Dr. 
MooVe. The Doctor informed me, that a few days before I saw 
this man, he was obliged to bleed him twice in one day, for an at- 
tack of the same kind. This disease proved to be an intermittent 
at Canton, and was extremely obstinate, but at length yielded to 
very large doses of opium and Cayenne pepper, after the failure 
of other remedies. 

I was requested to visit a man about 40, of a robust habit on 
board the Active, who had received a wound on the left side over 
the false ribs, with a Cutlass. After the most careful examina- 
tion, it did not appear to me to have penetrated the cavity of the 
thorax. He, however, complained of pain at intervals, shooting 
from the wounded part to the breast. The pain was not constant 
but when present was so acute, that I was induced to bleed him 
five or six times, and apply a blister in the course of two or three 
clays. — it at length put on the form of a double quotidian ; the par- 
oxysm coming on with chilliness, succeeded by the pain and fever 
and terminating in a sweat. This continued after the wound had 
healed entirely: the bark was directed. He left Wampoa, not 
perfectly well, though able to walk about, and recovei'ed his health 
at sea. 

Although it appeared very evident that the wound did not 

penetrate the thorax, I at first apprehended that the acute pain he 

^inplained of was caused by it ; but as it put on the form of a 



15 

double quotidian, is it not probable, that its occurring at this time 
was merely accidental ? 

January 12, 1806. The carpenter of the Active, a man about 
30 years of age, with a full frequent pulse, complained of great 
pain in his side. He had taken half a pint of blood from himself 
before I saw him, and the pain encreased after it. I immediately 
took away sixteen ounces more, which mitigated the pain very 
much. In an hour or two after he became quite delirious, his pulse 
seeming more active than before bleeding : when interrogated, he 
said that he still had some pain in his side, but in giving one or two 
correct answers, he would again become delirious. I left him, to 
prepare a dose of Calomel, but when I returned in a short time 
after, I was surprised to find him in a tranquil sleep. 

The next day he was quite sensible, complained of pain in 
his breast, and over his eyes, but of none in his side — pulse full 
and frequent, with a little cough. I took away ten ounces of blood, 
which produced faintness, and mitigated the pain — a dose of cas- 
tor oil was given. As soon as it began to operate, the pain in his 
side left him entirely, and that of his head was rapidly abating. — In 
the evening he left Wampoa for sea, quite relieved. 

Hepatitis. Of this disease I saw three cases. One under 
the care of Mr. Knight, who subdued the disease by two copious 
bleedings, the application of two blisters, and by purgatives with- 
out exciting salivation. One was the case of Capt. W. in whom 
all acute symptoms were removed by two bleedings, the application 
of a blister, with purgatives and antimonials — but, although Dr. 
Moore affected his mouth with mercury, he had not perpectly re- 
covered, when he arrived in Philadelphia. Some time after his 
arrival I saw him, and he informed me he was quite well. 

This gentleman, when I saw him, (and then he laboured 
under the disease in a very acute form,) complained of pain a- 
bout the third superior rib of the right side, but of jaoaae in hi- /I'M 
shoulder. 

The third case which had a less agreeable termination, was 
that of a man about twenty-five, on board the Active. No medical 



16 

person saw him until the fourth or fifth day after his seizure, 
when he was visited by Mr. Knight, who bled him, applied a blis- 
ter to the hypochondrium, and directed calomel in small and fre- 
quent doses. I saw him on the seventh day. He was unable to 
lie on his left side, as this posture created a sense of weight and 
tearing from the right side. He complained of pain in the right 
hypochondrium, but it was by no means so acute, as it had been 
on the preceding evening when he was bled. He complained of 
no pain in his shoulder, nor did he through the whole course of the 
disease. 

On examination, a tumor was found in the left side over the 
false ribs, whose surface was inflamed by the blister which had 
been applied over this part, and the skin for some distance around 
it had an emphysematous appearance. 

He said that he perceived this swelling about two days after 
the pain commenced in his side. No enlargement was percepti- 
ble either in the epigastrium, or below the false ribs. 

Another blister was applied over the hypogastric region, and 
the calomel was given in larger doses, combined with opium. 

On visiting him the next day, his gums were sore : he did 
not complain of pain in his side, and lying upon his left side did 
not cause so much uneasiness as on the preceding day. The ca- 
lomel was discontinued, as soon as the mouth became well af- 
fected. 

In a day or two, it was evident that the tumor contained a 
fluid. With the consent of Mr. Knight, I made an incision into 
it, an inch in length, which discharged about four ounces of a fine 
thick pus. He felt much relieved as soon as the matter was eva- 
cuated, his appetite became good, and he gained strength rapidly, 
not having any hectic symptoms. There was an oozing of mat- 
ter from the opening for a few days — it gradually decreased in 
quantity, and in about three weeks the wound healed. He sailed 
from Wampoa in perfect health. 

I met with several cases of dysentery, but observed nothing 
peculiar in it. In recent cases, it was generally very tractable 
under the use of castor oil, and the neutral salts, with the cau- 
tious use of opium. 

I am, Sec. HUGH SERVICE. 



17 

Observations on the mode of treatment 
pursued by Dr. Clark. 

This celebrated physician recommends attacking the most 
powerful form of disease that occurs in India and China, with gen- 
tle vomits and purges.* The object of these, was to clear the in- 
testinal canal, and prepare the way for the immediate exhibition 
of the bark ; and for this purpose he advises the exhibition of tar- 
tar emetic in small doses, to render the operation of which more 
certain, he combined with it a little manna, decoction of tamar- 
inds, or a few grains of Calomel .--Or, in cases of great pain in the 
stomach, attended with deliquium, instead of" commencing with 
these evacuations, he found it necessary in order to relieve the pain 
to give one grain of opium immediately on the attack of the fever, 
f. apply fomentations to the region of the stomach, and to open the 
bowels by glysters. When the inflammation in the stomach ran 
high he was deterred from giving any thing more powerfully eme- 
tic than chamomile tea, mitigating the pain and vomiting with 
opium, and afterwards opening the bowels with a decoction of tama- 
rinds and magnesia. His cure then entirely depended upon giv- 
ing the peruvian bark, in as large doses as the. patients stomach 
would bear, without paying any regard to the remissions or exa- 
cerbations of fever.'' 

With respect to bleeding he observes, " that from the vio- 
lence of the symptoms, he thought it might require at least one 
bleeding : and finding the same evacuation recommended by Dr. 
Huck and Dr. Cleghorn, he was induced to open a vein during the 
paroxysm in three of his patients at Culpee." The consequence, 
he informs us was, the first did not bear the evacuation ; his pulse 
flagged, and he was very delirious in the ensuing fit ; the remis- 
sions becoming very obscure ; and the exacerbations were only to 
be known by his delirium. The other two were seized very sud- 
denly and fell down in a deliquium ; on opening a vein they re- 
turned to their senses ; but before 5 or 6 oz. of blood were taken 
away, they became faint ; and the feverish paroxysm ran higher 
than in those who did not sufler the evacuation. Tor the future, 
he was determined to be very cautious in the use of blood-letting, 

* Clark, on the Diseases of long Voyages, fce.sec 2 Edt. pag-e 180. 

C 



and, therefore laid it aside in every fever in warm climates, both 
at sea and on shore, unless accompanied with topical inflamma- 
tion."* 

Had I pursued this gentle treatment, I am satisfied, that 
where death would not have been the consequence, the continued 
or typhus form of fever would have been induced. With respect 
to the peruvian bark, I found that its exhibition was uniformly 
hurtful, or at least inefficacious till after the inflammatory diathe- 
sis was completely subdued. I never had any cause to regret not 
giving it in time, but on the contrary, from fear that was excited 
in me by reading, I had to regret giving it too early. 

As for cases of that violent description, attended with deliqui- 
um and excessive pain in the stomach, I will only remark, that in 
a case of this kind, to which I was called, the patient had com- 
plained of the most excruciating pain in his stomach, soon aft a* 
which he fell down in' a deliquium. In this situation I saw him, 
and immediately drew 12 ounces of blood, which restored bim to 
his senses, but so excessive was the pain, that he soon became de- 
lirious, till by the exhibition of a large dose of Calomel and jalap, 
I removed the cause, when he speedily recovered, without the use 
of either opium, fomentations, or the bark. 

It appears from the Doctor's account of blood-letting, that 
except in cases of topical inflammation, he laid it aside altogether, 
IVom the conviction that his patients could not bear the evacuation. 
Why it should be better borne in cases of equal violence, attended 
with topical inflammation, I am at a loss to conceive, and I am 
induced to believe, that even in those cases he has men'ioned, 
wherein the patients were seized suddenly with deliquium, and 
who, after the loss of a few ounces of blood, which restored them to 
their senses, became again fainty, might afterwards have been bled 
more copiously with advantage : as he informs us that the feverish 
paroxysm which succeeded, \wn higher than in those who did not 
suffer the evacuation — The reason appears obvious — The force of 
the disease was greater in the former, and the deliquium was a 
symptom, not of pure debility, but of depression ; hence the loss 
of a few oz. of blood, only served to unlock the disease or to use 
the emphatic words of Dr. Rush, " to let the tiger loose." after 
which he ought to have been tamed by more bleeding. 

* Clark, on the Diseases of long voyages, 8cc. see page 170 



19 

The improper application of remedies, has occasioned some 
ol the most valuable to be condemned as pernicious, or laid aside 
as useless. The antiphlogistic mode of treatment, as practised by 
manxj of the English physicians, appears to me to be as little calcu- 
lated for success, as the stimulating or tonic plan. When bleed- 
ing* was- employed, it was often in so sparing a manner as not to be 
effectual or beneficial, and their evacuating remedies, which con- 
sisted principally of antimonials, given in shall doses, were so fee- 
ble, that when evident remissions or intermissions occurred, which 
they patiently waited for, the disease had so far exhausted the pa- 
tient, as to render the bark and every other remedy ineffectual. 

I shall only remark further on the subject of blood-letting, 
that, although it did not appear to be essentially necessary in eve- 
ry case, (and some cases were subdued without it,) yet from the 
success which always followed its use, I had to regret my timi- 
dity in not using it more generally.! 

* In cases attended with violent pain in the head, Dr. Lind 
advises the loss of a few ounces of blood from the foot, but ob- 
serves, " that it must be drawn with great caution." 

f Owing, as I sincerely believe to my with-holding- the lancet, and o- 
ther depleting remedies, and pushing the bark too early, a few cases wen- 
protracted, and rendered dangerous. In one case of Remittent fever ac- 
companied with violent pain on one side of the head, which extended with 
marks of inflammation down the face, and the eye on that side much in- 
flamed, although the patient was bled twice, pretty freely, yet as no power- 
ful cathartics were administered, and the bark given in the remissions, the 
disease still progressed, till I laid aside t'.ie bark and perfected the cure 
with Calomel. 

I was near losing another from the same cause in the third paroxysm 
of an apoplectic tertan. In this case after cleansing the bowels with a large- 
dose of Cal. and Jalap, I poured in the hark. So severe was the third par- 
oxysm that the pr.ticnt lav comatose, his respiration was difficult, with deep 
and heavy sighs, sudden involuntary starting, and dilatation of the pupilsof 
his eyes.' I now gave him Calomel freely, combined with a little tartar 
emetic. The fourth paroxysm was moderate, and I prevented the recur- 
rence of the fifth, by the application of blisters and a large dose of opium 
He now recovered 0:1 stimulating aliment which his stomar-li craved, and 
which precluded the necessity of giving the bark. 



20 

Making comparative statements of the mortality that at- 
tends different modes of treating diseases to enable us to judge of 
the most successful, may sometimes be fallacious ; but as I know 
of no better criterion, I may observe, that of 19 cases, which Dr. 
Clark has recorded, of the remitting fever which occurred in India, 
at sea and in China, six proved fatal, and most of the others recover- 
ed with great difficulty. None were restored in less than a week, 
and the cure of several was protracted to a month and upwards.* 

In the practice that was pursued at Wampoa and Canton, 
by myself and others, not a single death occurred to my knowledge, 
where timely application had been made, and where prompt atten- 
tion was given. Three deaths only occurred that came under my 
notice, two in August, and the other in September. The first 
had beeti indisposed for ten days before medical aid was resorted 
to. 1 he second had been visited, it is true, on his first attack, but 
was afterwards neglected, till the disease had progressed so far, 
■that it could not he arrested, and the third was not seen till seve- 
ral days had transpired. 

I have been since informed, that shortly after I left Wampoa, 
the small ppx made its appearance among the New-England ships, 
and proved fatal to several. 



Account of Diseases which occurred on 
the passage home. 

We sailed for America, on the 30th of November, at which 
time, as has already been stated, the weather had become cool, 
We had not at this time any cases of sickness on board worthy of 
remark. As we approached the low latitudes, however, in the Chi- 
na sea, and the weather became wet and sultry, some cases occur- 
red which I shall briefly notice. The patients were seized with 
slight chills, attended with pain in the head and bones, great op- 
pression about the praecordia, and universal languor. I bled, and 
cave strong mercurial cathartics, with the same success I had be. 
fore done in port. In one case attended with pain in the side, I 

i 6 ounces of blood, gave a strong mercurial cathartic, and the 

* Clark on the Diseai . 133 



21 

ensuing day the patient was enabled to attend to moderate duty. 
In another case, the patient was restored to duty in a few days by 
the use of twenty-five grains of calomel, thirty-five of jalap, and an 
ounce of the sulphate of soda. 

On the 18th of December we past through the straits of Sunda. 
The weather had been very sultry, with heavy showers of rain, 
thunder and lightning, particularly during a passage of five days 
through the straits of Gaspar and the Java sea. We had now sev- 
eral days of wet weather, damp, chilly and disagreeable. During 
this time, two of the most troublesome cases of disease occurred 
that I had met with.* The patients were first seized with fevers of 
the intermittent form, which being mild in one of them soon yield- 
d to the bark. In a short time however, he relapsed again, and 
before I was able to subdue it the second time, a severe lax came 
on, attended with griping, tenesmus, and a discharge of blood and 
mucus. By the use of calomel and rhubarb,opium and ipecacuanha, 
and the application of blisters, the pain and tenesmus had nearly 
subsided, and the stools became much less frequent on the seventh 
day. The patient was now much debilitated, and still had no ap- 
petite. The stools continued and increased again in frequency, 
but they were unaccompanied with pain. 

I now as a last resource, combined with the opium two grains 
of the sugar of lead, which I repeated but a few times, when his 
appetite returned, and he recovered fast from a state of great de- 
bility. His legs swelled for a short time, but in little more than 
a week he was again on duty. 

In the other case the intermitting fever was much more ob- 
stinate, but I at length succeeded in checking it by large doses of 
opium, and the patient had by the use of the bark recovered con- 
siderable strength, when he was seized with a diarrhoea. This con- 
tinued for four clays, without being alleviated by any of the means 
which I employed. The stools were frequent, but in small quan- 
tity of a thin slimy consistence, and were unaccompanied with 
griping or tenesmus. From the debility which was now induc- 
ed, 1 began to be alarmed for the fate of my patient, and had re* 
course to the acetate of lead, which I began with as follows. 

* A barrel of Beef was at this time undergoing- the putrefactive pro- 
cess in the forecastle. 



22 

Dec. 26th. Gave o:vj grain of the sugar of lead in a watery 
solution, which I repeated in the evening. 

27th. Stools less frequent, but I gave during the day four 
grains of the medicine. At night the stools were increased in fre- 
quency. 

28th. During the forenoon the stools were as frequent as 
they had been during the whole course of the disease. In the 
morning I gave two grains of the medicine at a dose. In the after- 
noon he took six grains at three doses, with a grain of opium at 
bed time. The stools were notwithstanding very frequent during 
the night. 

c 

29th. Had no motion all day, and took nothing. During 
the night he had two moderate discharges from his bowels, and 
having in his possession two of the powders, each containing 
three grains, on rising to stool he took one each time, contrary 
to my directions. ' 

31st. Having had no passage through his bowels since the 
night of the 29th, and feeling some little pain and stricture in 
his stomach, I felt alarmed for the effects of this powerful and 
dangerous medicine. I gave him small doses of rheubarb, till an 
operation was produced, which had the happy effect of removing 
these symptoms. His appetite returned, and he recovered so ra- 
pidly, that in a few days he was again on duty. 

I cannot conclude without observing, how much it is to be re- 
gretted, that the merchant ships are not more generally furnish- 
ed with Physicians, especially when it is considered how extensive 
the trade has become, and how profitable East-India voyages arc. 
1 f the lives of our seamen are considered of any importance, either 
in a moral or commercial point of view, some regard ought surely 
to be extended toward the preservation of their lives, in those cli- 
mates where diseases are rapid in their progress, and too general- 
ly fatal in their termination, without the prompt aid of the Phy- 
sician. ' 



23 

Conclusion* 






For the imperfections of this narrative, I must plead want of 
time and bodily indisposition. I have endeavoured as briefly as I 
could to give a correct statement of the diseases which came un- 
der my notice, and my treatment of them. In this it was my aim to 
accommodate my remedies to the states and symptoms of disease, 
unbiassed by favorite theories or popular opinions, which have of- 
ten retarded improvements in the healing art. I must, however, 
in justice to the enlightened professor of the institutes and prac- 
tice of medicine in this University, acknowledge that it was from 
him I imbibed the principles which I have applied in my practice, 
and they certainly possess this peculiar advantage, that they di- 
rect the attention of the student to the state of the system, instead 
of the name of the disease. 

Of the illustrious Professors in this University, I now take 
my leave. They individually claim from me a tribute of the 
warmest respect. That I may ever merit their esteem and friend- 
ship, is my ardent wish. With Professor Barton, I have had the ho- 
nour of a more intimate acquaintance, and am happy in declaring 
how much this acquaintance has contributed to my happiness. His 
zeal for the promotion of science in general, and the success that 
has attended his valuable labours, in exciting a spirit of useful en- 
quiry, reflect ecmal honour on himself and the profession of which 
he is so worthy a member, and will entitle him to the prase and gra- 
titude of his country and mankind. 




MeuL Hut. 

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1*07